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Gout: Sufferers know to toe the line with a proper diet

Sunday, November 04, 2001

By Jane Miller

Cookbook author Jodi Schneiter liked to give lavish dinner parties for up to 25 guests in the Florida home she shared with her first husband. Years later, she still remembers the calls she got the morning after.

"A friend used to call up the next morning and say, 'I don't know what you fed me, but I had the worst gout attack.' "

Stacy Innerst, Post-Gazette illustration

Schneiter, now 38, thought the friend was a whiner. Gout sounded like a funny affliction. She imagined a king with an enormous toe resting on a velvet cushion.

In fact, four years ago, she whimsically named her first cookbook of lavish desserts "The Gout Lover's Cookbook" --the book was filled with fatty dishes that any person afflicted with gout should avoid.

She soon found out there's nothing funny about gout, a rheumatic disease that can cause burning pain that lasts for several days at a time in the joints. Some gout sufferers found Schneiter's cookbook while doing computer searches and didn't realize the title was a joke.

She said cookbook orders flowed in. So did letters asking, "Where are the recipes for the gout?"

Schneiter stopped selling the cookbook. "We sent notes to customers and bookstores saying, 'This is probably what your customer does not want. They probably have gout and probably want the opposite,'" she recalled.

She discovered through the Arthritis Foundation that more than 2 million people suffer from gout.

Dr. Robert Potter of Northern Area Family Medicine, McCandless, sees a case of acute gout -- where the patient has a "hot and red joint," as he calls it -- about every other week. Gout can usually be controlled through diet, but not always, he said.

"Some people, no matter how much they control their diet, have more of a problem with reoccurring flare-ups than others," he said. High uric acid levels also may contribute to kidney stones. Primary-care doctors treat most of the gout cases, but severe cases may be referred to a rheumatologist, who specializes in arthritic diseases.

Gout is considered the only form of arthritis on which diet can have an impact.

Gout inflammations occur when the body cannot rid itself of uric acid. Uric acid is a crystallized by-product of foods high in purine, a chemical compound the body uses to relay messages and signals within the cells. Normally, the kidneys eliminate uric acid. When they don't, the crystals settle around the joints, causing the painful attacks, explains Tahma Metz, of the Purine Research Society in Bethesda, Md.

Sufferers should avoid foods highest in purines, including red meats and especially organ meats. Other foods to avoid are alcohol, coffee, tea, cola drinks and foods that contain additives such as MSG (found even in Worcestershire sauce), xanthan gum and hydrolyzed vegetable proteins, used for flavorings or preservatives.

Foods moderately high in purine levels, to be eaten sparingly, include fish, poultry, turkey and beans. Spinach, mushrooms, asparagus, bran and wheat breads are also on this list.

A restricted purine diet includes most vegetables, fruits, milk and breads, except for whole grains. Cherries have traditionally been recommended to gout sufferers.

"There is no proven reason why it works, but some people who suffer gout swear that if they eat a half- pound of cherries a day, they don't get the gout," Schneiter said.

Yet she didn't find any cookbooks. "There was nothing out there -- only lists of foods to eat or avoid."

In 1999, she self-published "The Gout Hater's Cookbook." Since then, the $15 book has sold 15,000 copies, which have gone to most states, as well as Asia, Australia, Africa and Europe.

Although gout is stereotyped as an affliction that more commonly hits men, usually in the big toe, it can afflict women and other parts of the body as well.

The book is one of the "gout busters" for Upper St. Clair's Stacy Harris, 49, who described "burning pains" in the joints of her arms for a year before she found the book through Schneiter's Web site.

"There's nothing else like this [book] out there. It's a good cookbook. I've enjoyed the recipes. I find that if I avoid meat and caffeine, it's pretty much under control," she said. Harris also takes an herbal supplement that contains garlic, which she found in her online research about her medical condition.

Metz praised Schneiter's recipes for a modified diet, as well as the restricted diet that is necessary for children who have autism associated with a build-up of uric acid in their bodies.

"Jodi has researched her topic thoroughly and carefully. She has interesting, tasty, healthy recipes that are quick and easy to make," Metz said.

The Purine Research Society, created in 1986, is dedicated to research and awareness of purine metabolic diseases, particularly purine autism, the "largest subgroup of autistic children," which usually is diagnosed by adolescence.

In Schneiter's sequel, "Gout Hater's Cookbook II," due around Christmas, all recipes will be acceptable for the restricted purine diet. The first gout hater's book had a few recipes that use meat but extend it. "Some doctors tell their patients they can have up to 4 ounces a day of foods that are high in purines," Schneiter said.

Although medications can help control gout attacks in adults, some unpleasant side effects include diarrhea, cramping and nausea, or in other words, says Schneiter, "enough reason to change your diet right there."

When a dish's taste and texture aren't sacrificed, she uses egg whites instead of whole eggs or skim milk instead of 2 percent to lower the fat and sugar content, for an overall more healthful diet.

She recommends adapting family favorites to fit a gout sufferer's diet.

"The first thing I do is to take a recipe I know and like. I substitute with items low in purine," says Schneiter, of Palm Coast, Fla.

Not every try produces a success. Since yeast is high in purines, she has created breads without yeast, substituting baking powder. "My worst disaster was a loaf of raisin bread that rose 8 inches out of the pan," she says with a laugh.

Recipes are tested on her husband, Tom, who -- by the way, does not have gout -- and their daughter, Yvonne, 12. The couple are expecting a baby in December.

What's her husband's reaction to her gout-hating recipes? "He says it's just not as bad as it seems," she jokes.

But Schneiter is serious about her mission. "Once you get away from the idea that you are eliminating part of your diet and get into the idea of being creative, you come up with some wonderful, wonderful foods."

Schneiter's books are available at Border's Books & Music or on her Web site, www.gout-haters.com/.

Jane Miller is a free-lance writer living in Avalon. Her husband is a former sufferer of gout.

Related PG Tested Recipes

Stuffed Jalapenos


• 18 fresh jalapenos
• 5 egg whites or same amount of egg substitute
• 1 small onion
1/2 cup water
• 1 small package cornbread stuffing mix
1/4 cup skim milk
• 2 cloves garlic

Cut jalapenos in half lengthwise and remove seeds. Lay out in rows on cookie sheet(s). Cook 1/2 of eggs in a nonstick skillet and set aside to cool. Mince onion and saute in water until transparent. Set aside. Prepare stuffing according to directions on package. Place in mixing bowl. Add onion, remaining eggs, milk and garlic. Chop cooked eggs and add to mixture. Mix by hand until all ingredients are thoroughly combined. Spoon mixture into jalapeno halves.

Bake at 375 degrees for about 30 minutes or until stuffing tops are browned and jalapenos have become slightly tender. Cool for 10 minutes and serve.

Tester's note: We used a variety of hot peppers. This was a popular Labor Day picnic appetizer. Be sure to protect your hands while removing seeds. We put plastic bags over our hands.

"The Gout Hater's Cookbook" (third edition, revised) by Jodi Schneiter


Lasagna


• 1 package (32 ounces) lasagna noodles
• 11/2 cups fat-free ricotta or cottage cheese
• 2 jars (26 ounces each) spaghetti sauce (no meat or mushrooms)
1/2 pound reduced-fat mozzarella cheese
1/2 pound reduced-fat provolone cheese

Prepare lasagna noodles according to package directions. Drain, rinse and set aside. Grate hard cheeses, combine, and set aside. Lightly coat a deep 4-quart baking dish with olive oil. (Schneiter's pan measures 10 1/2 by 15 inches.) Place one layer of lasagna noodles in bottom of dish. Spread an even layer of sauce over noodles.

Over sauce, place a layer of ricotta, mozzarella and provolone cheeses and cover with a generous amount of sauce.

Continue layering ingredients beginning with noodles, until all ingredients have been used, ending with a layer of noodles.

Cover with a layer of sauce so the top layer will not burn in the oven.

Place in a 350-degree oven and bake for about 45 minutes or until sauce on top begins to brown. Serves 6.

Tester's note: This is a moist and cheesy dish. A gout sufferer said this was one of the tastiest lasagnas he's sampled.

"The Gout Hater's Cookbook" (third edition, revised) by Jodi Schneiter


Sweet Potato Pie


• 1 reduced-fat 9-inch piecrust, unbaked
• 3 egg whites (or egg substitute equal to 2 eggs)
3/4 cup sugar
• 1 teaspoon ground cinnamon
1/2 teaspoon salt
1/2 teaspoon ginger
1/4 teaspoon ground cloves
1/8 teaspoon allspice
• 2 cups canned sweet potatoes, mashed
• 1 cup skim milk

Preheat oven to 425 degrees. Set aside piecrust. (We couldn't find a reduced-fat piecrust, so we used a regular one.) Combine remaining ingredients in a medium mixing bowl. Blend with electric mixer until smooth. Pour into piecrust, and cook at 425 degrees for about 15 minutes. Reduce the temperature to 350 degrees, and continue baking for about 45 minutes or until a toothpick inserted in the center comes out clean. Remove pie from oven, cool, then chill in refrigerator overnight or for at least 4 hours. Serve with ice cream or nonfat vanilla yogurt.

"The Gout Hater's Cookbook " (third edition, revised) by Jodi Schneiter

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